Originally published July 1, 2015
treatment outcomes of patients infected with Hepatitis C virus: a
systematic review and meta-analysis of the survival benefit of
achieving a Sustained Virological Response–B Simmons, et. al
Source: Clin Infect Dis
. 2015 May 17. pii: civ396. [Epub ahead of print]
Results and Conclusions: In the
current study the authors conducted an electronic search to identify if
achieving a cure improved long term outcomes. The records of 33,360
patients from 31 studies were examined with a medium follow-up period
of more than five years. The people who were cured were compared to
those who were not cured.
The Bottom Line: The survival
after five years from being cured was significant compared with those
who did not achieve a cure. This included three populations of
people—those who were HCV mono-infected, those who had cirrhosis and
those who were coinfected with HIV and hepatitis C.
Editorial Comment: In science
studies are needed for everything, and this is an important one because
it proves that successful treatment works to prolong lives. More of
these studies (with larger patient populations) are required to
convince insurance companies and other payers that in the long run
paying for treatment saves them money and, more importantly, lives.
Results and Conclusions: Methadone
is used for withdrawal/substitute for opioid use. In this study
people who were entering Rhode Island Department of Corrections and who
were currently enrolled in a methadone maintenance program at the time
of arrest were asked to enroll in a study that would continue them on
methadone maintenance while they were in prison. Participants were
only included in the study if they were to be incarcerated for more
than 1 week but less than six months. The participants in the study
were randomized by a computer-generated program by sex and race. The
trial took place between June 2011 - April 2013.
After release from prison the study paid for ten weeks of methadone for the methadone group if financial help was needed.
The standard withdrawal protocol was to receive
methadone for 1 week at the dose at the time of their incarceration,
then a tapered withdrawal regimen (for those on a starting dose >100
mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3
mg per day to 0 mg; for those on a starting dose >100 mg, the dose
was reduced by 3 mg per day to 0 mg).
The Bottom Line: The participants
who were given methadone were more than twice as likely than the
forced withdrawal group to return to a community methadone clinic in
their community within 1 month of release—96% vs. 78%. There were no
serious side effects in either group.
Editorial Comments: Providing
methadone seems very humane. It also reduces hospital admission,
emergency-room visits and greatly increases the chances that once a
prisoner is released they would seek out a methadone clinic.
Methadone groups: one death, one non-fatal overdose, one hospital admission and 11 emergency-room visits
Forced-withdrawal groups: no deaths, two non-fatal overdoses, four admissions to hospitals, 16 emergency-room visits
Labels: Long term outcomes, methadone, Snaphots